Rekha S, Shirisha P, Muraleedharan V R, Vaidyanathan Girija, Dash Umakant
Department of Humanities and Social Sciences (DoHSS), Indian Institute of Technology (IIT), Madras, India.
Institute of Rural Management Anand, Gujarat, India.
Dialogues Health. 2023 Apr 23;2:100135. doi: 10.1016/j.dialog.2023.100135. eCollection 2023 Dec.
BACKGROUND: Undernutrition remains a major public health concern in India, especially among children belonging to the Scheduled Tribes (ST). In this study, we analyse wealth inequalities in nutritional outcomes within ST communities in two tribal-dominated states of India, namely, Odisha and Jharkhand. The study also compares the trends in nutrition outcomes between ST and Non-ST children in these states. METHODS: We have conducted a trend analysis of the prevalence and inequalities in the nutritional indicators among ST children under age five using unit-level data of the National Family Health Survey (NFHS) [NFHS-3(2005-06),4 (2015-16) and 5(2019-2021)]. Wealth-related inequalities were analysed using the Slope Index of Inequality (SII), which measures absolute inequality, and the relative Concentration Index (CIX), which measures relative inequality. We have also analysed the correlation between Antenatal Care (ANC) visits and nutritional indicators using the Pearson Correlation test. RESULTS: The trend analysis shows that the prevalence of undernutrition remains higher among ST children in India as compared to Non-ST children between NFHS-3 (2005-06) and NFHS-5 (2019-2020) in Jharkhand and Odisha. The SII and CIX values show that statistically significant inequalities in stunting and underweight exist among children belonging to various wealth quintiles within the ST category in both states. Wasting is found to be significantly prevalent across all wealth quintiles. Also, we found a negative association between ANC visits and all three nutritional indicators. INTERPRETATION: Our study highlights the importance of monitoring both the absolute and relative wealth inequalities in nutritional outcomes. This is due to the fact that while inequalities across groups may reduce, the prevalence of poor nutritional outcomes may increase among certain groups. Such observations, therefore, will enable policymakers to focus further on those groups and devise appropriate interventions.
背景:营养不良仍是印度主要的公共卫生问题,尤其是在属于 scheduled tribes(ST,即在册部落)的儿童中。在本研究中,我们分析了印度两个部落主导的邦——奥里萨邦和贾坎德邦——ST 社区内营养状况的财富不平等情况。该研究还比较了这些邦中 ST 儿童和非 ST 儿童营养状况的变化趋势。 方法:我们利用全国家庭健康调查(NFHS)[NFHS - 3(2005 - 06)、4(2015 - 16)和 5(2019 - 2021)]的单位层面数据,对 5 岁以下 ST 儿童营养指标的患病率和不平等情况进行了趋势分析。使用不平等斜率指数(SII,用于衡量绝对不平等)和相对集中指数(CIX,用于衡量相对不平等)分析了与财富相关的不平等情况。我们还使用皮尔逊相关检验分析了产前检查(ANC)次数与营养指标之间的相关性。 结果:趋势分析表明,在贾坎德邦和奥里萨邦,在 NFHS - 3(2005 - 06)至 NFHS - 5(2019 - 2020)期间,印度 ST 儿童的营养不良患病率仍高于非 ST 儿童。SII 和 CIX 值表明,在这两个邦的 ST 类别中,不同财富五分位数的儿童在发育迟缓及体重不足方面存在统计学上的显著不平等。在所有财富五分位数中,消瘦情况都显著普遍。此外,我们发现 ANC 次数与所有三项营养指标之间存在负相关。 解读:我们的研究强调了监测营养状况方面绝对和相对财富不平等的重要性。这是因为虽然不同群体之间的不平等可能会减少,但某些群体中不良营养状况的患病率可能会增加。因此,此类观察结果将使政策制定者能够进一步关注这些群体并制定适当的干预措施。
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